Decision Making on Medical Innovations in a Changing Health Care Environment

Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

Julia R. Trosman, Christine B. Weldon, Michael P. Douglas, Patricia A. Deverka, John B. Watkins, Kathryn A. Phillips

Research output: Contribution to journalArticle

Abstract

Background New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. Objectives To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. Methods We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision making in terms of achieving a balance between the components of the Triple Aim—improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations.

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalValue in Health
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Accountable Care Organizations
Precision Medicine
Technology
Delivery of Health Care
Decision Making
Health Care Costs
Clinical Decision-Making
Biomedical Technology Assessment
Qualitative Research
Quality of Health Care
Social Responsibility
Population

Keywords

  • accountable care organizations
  • coverage policy
  • decision making
  • personalized medicine

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Decision Making on Medical Innovations in a Changing Health Care Environment : Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies. / Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John B.; Phillips, Kathryn A.

In: Value in Health, Vol. 20, No. 1, 01.01.2017, p. 40-46.

Research output: Contribution to journalArticle

Trosman, Julia R. ; Weldon, Christine B. ; Douglas, Michael P. ; Deverka, Patricia A. ; Watkins, John B. ; Phillips, Kathryn A. / Decision Making on Medical Innovations in a Changing Health Care Environment : Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies. In: Value in Health. 2017 ; Vol. 20, No. 1. pp. 40-46.
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